Are budget cuts to health departments putting our health at risk?

Providing care for mothers and babies, preventing the spread of communicable diseases and responding to emergencies are among the services provided by local health departments, which have faced devastating cuts in the past several years.

A 2011 National Association of County and City Health Officials (NACCHO) survey of local health departments nationwide found that more than half of all departments cut services in the first part of 2011, with maternal child health services the “hardest hit.” According to a 2011 National Association of County and City Health Officials report, since 2008, local health departments nationally have lost 34,400 out of a total 155,000 jobs due to layoffs and attrition This loss of capacity is expected to threaten the health of the communities these agencies serve.

Betty Bekemeier is looking at the effects of budget cuts on county health services.

To better understand what this means for the public, Betty Bekemeier, assistant professor of of psychosocial and community health in the UW School of Nursing, has been funded to look at the effects of these cuts on county health departments.

The project will examine how cuts have affected the community—from the health of mothers and babies to infectious disease control. Bekemeier and her team of public health practice-oriented researchers will investigate the types of cuts made to local health departments in maternal and child health (such as support for low income pregnant and parenting women in getting healthcare and information), environmental health (such as water supply and food safety monitoring), and communicable disease control (such as immunization programs and tuberculosis control). The researchers hope to ultimately find what works best for improving health outcomes for the public, even in a time of diminishing budgets and cutting programs.

“As we have more evidence, we will be able to better inform policy makers about the impact that these services have on communities … and what happens when they go away,” said Bekemeier. “But without adequate evidence of what each of these services do for the health of our communities and how to prioritize them, local public health leaders and policy makers are struggling to make very difficult decisions about what will best meet the needs of their communities, especially during these tough financial times.”

Bekemeier, alongside co-Investigator Michael Morris at the University of Arkansas for Medical Sciences, will use funding from The Robert Wood Johnson Foundation (RWJF) to look at six years of data from 305 health departments in four states (Washington, Florida, Minnesota and Ohio) related to changes in services and the impacts of these changes on the populations that are served.

Using the health departments as a “living laboratory,” the project will study 2005-2010 data from health departments, from before and after budget cuts to services, and how these cuts are affecting people in the community. Cuts in health departments have included reducing and eliminating home visiting programs for new mothers, ending free immunization clinics, and slower responses to infectious disease outbreaks.

Bekemeier notes that the four states were selected because theyve all faced significant budget cuts, they all have detailed data that support this type of study, and they each have existing Public Health Practice-Based Research Networks (PBRNs). Such partnerships between public health practitioners and researchers make studies like this possible. Practitioners can make health data more accessible to researchers and researchers can be more responsive to the questions that people in practice need answered.

With each health department handling cuts differently, Bekemeier notes that the overall impact to the populations served may be different across states and in rural versus urban communities. According to Bekemeier, nurses make up the majority of the workforce in city and county health departments, so they play an important role in understanding how the health departments are meeting the needs of those they serve.

“This financial crisis, awful as it is, is giving us an opportunity for a ‘natural experiment,” she said. “These terrible cuts to services will give us a much better sense of how these services contribute to peoples health. Then we will need to use these findings as evidence to support programs and practices that meet the needs of our communities most vulnerable residents. Nurses are the backbone of our public health systems. So we have a huge responsibility to be a part of understanding and providing leadership around these issues.”

The two-year, $200,000 grant from The Robert Wood Johnson Foundation (RWJF) in conjunction with the National Network of Public Health Institutes (NNPHI) is one of 11 grants given to institutions across the country. The projects are part of a broad effort to support research on strategies to improve the quality and effectiveness of public health practice and policy.

“These are trying times in public health and any form of public service,” said Dr. F. Douglas Scutchfield, a physician and director of the National Coordinating Center of Public Health Systems and Services Research. “How best to cope with the changing environment at the state and local levels – in health departments generally and in specific programmatic areas such as maternal and child health – is the goal of these projects. The intent is to inform decision making in a rapidly evolving public health system.”

As the nations largest philanthropy devoted exclusively to health and health care, The Robert Wood Johnson Foundation addresses the pressing health and health care issues facing the United States. For more information about this project, visit www.rwjf.org, www.publichealthsystems.org and www.nnphi.org.